Provider Demographics
NPI:1730358482
Name:BEHAVIORAL CONNECTIONS OF WOOD COUNTY INC
Entity type:Organization
Organization Name:BEHAVIORAL CONNECTIONS OF WOOD COUNTY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:419-352-5387
Mailing Address - Street 1:PO BOX 29
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-0029
Mailing Address - Country:US
Mailing Address - Phone:419-352-5387
Mailing Address - Fax:419-352-6033
Practice Address - Street 1:1010 N PROSPECT ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-1335
Practice Address - Country:US
Practice Address - Phone:419-352-5387
Practice Address - Fax:419-352-6033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-27
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0318261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2474068Medicaid